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Int J Chron Obstruct Pulmon Dis. 2014 Oct 17;9:1163-86. doi: 10.2147/COPD.S68289. eCollection 2014.

Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD.

Author information

1
University of Groningen, Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, Groningen, the Netherlands.
2
Respiratory and Intensive Care Medicine, Cochin Hospital Group, APHP, Paris-Descartes University (EA2511), Paris, France.
3
Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center and George Washington University School of Medicine, Washington DC, USA.
4
Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
5
Department of Medicine, National Jewish Health, Denver, CO, USA.
6
Dept of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, the Netherlands.
7
Blizard Institute, Queen Mary University London, London, UK.
8
Research in Real Life, Ltd, Cambridge, UK.
9
Respiratory, Global Scientific Affairs, Teva Pharmaceuticals, Frazer, PA, USA.
10
Research in Real Life, Ltd, Cambridge, UK ; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Abstract

PURPOSE:

Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD.

PATIENTS AND METHODS:

Smokers and ex-smokers with COPD ≥ 40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection.

RESULTS:

Mean patient age was 67 years, 57%-60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32-4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients).

CONCLUSION:

We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years' follow-up.

KEYWORDS:

COPD exacerbation; extrafine particle; matched cohort analysis; real life; small airways

PMID:
25378918
PMCID:
PMC4207569
DOI:
10.2147/COPD.S68289
[Indexed for MEDLINE]
Free PMC Article

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